Table 1.

Recommendations for vaccination in pediatric patients with atopic dermatitis treated with dupilumab based on our modified-Delphi process

Initial statements	Level of agreement (%)	Final statements/recommendations	Level of agreement
Dupilumab interferes with humoral or cellular immune responses to vaccines but does not appear to affect the development of protective titers	2 (40) neutral 3 (60) disagree	Based on available data, dupilumab does not appear to affect the development of protective antibodies titers to inactivated vaccines	100% strongly agree
Dupilumab should not be interrupted for inactivated vaccines	3 (60) strongly agree 2 (40) agree	Dupilumab treatment does not need to be interrupted for administration of inactivated vaccines	100% strongly agree
Seasonal and pandemic influenza vaccination should not be avoided while on dupilumab	2 (40) strongly agree 3 (60) agree	For patients on dupilumab treatment, seasonal inactivated influenza vaccination should continue as recommended	100% strongly agree
Live vaccinations should be given prior to dupilumab if possible	1 (20) strongly agree 4 (80) agree	Based on available data, live attenuated vaccines should be avoided while on dupilumab	100% strongly agree
Live attenuated vaccines should be avoided while on dupilumab	4 (80) agree 1 (20) neutral	When live attenuated vaccinations are required, they should be given at least 4 weeks prior to initiation of dupilumab treatment, if possible	100% strongly agree
Measurement of antibody levels after vaccination is necessary to ensure serologic protection	1 (20) agree 3 (60) neutral 1 (20) disagree	While on dupilumab, measurement of specific antibody levels can be considered to ensure serologic protection after vaccination on dupilumab therapy	100% strongly agree
There is no risk of atopic dermatitis exacerbation with immunization on dupilumab	1 (20) agree 4 (80) neutral	There is no evidence to suggest that immunization while on dupilumab causes an exacerbation of atopic dermatitis	100% strongly agree